Mod 33 The Concept of Reproduction W/RATIONALs

fetal period

9 weeks to birth teratogens less likely to cause damage CNS is vulnerable all through pregnancy

A patient has been taking a medication associated with adverse developmental outcomes for the fetus. Which priority action should the nurse take based on this finding? Notify the registry of the drug exposure. Review the summary in the pregnancy subsection of the label. Review the warning label on the medication. Review the chart for the prescribed medication order.

Notify the registry of the drug exposure. The priority action by the nurse is to notify the registry of the patient's exposure to the drug. If the drug has been identified as a potential teratogen, it is not necessary to review the summary in the pregnancy section of the label. The warning label on the medication may not contain information specific to the pregnancy. Reviewing the prescribed order does not change the fact that the patient has been taking the drug.

TPAL

Term, preterm , abortion, living children Para: Birth

hCG (human chorionic gonadotropin)

What do at-home pregnancy tests detect in urine? maintains pregnancy until placenta takes over

Presumptive signs of pregnancy

changes that might make a woman think she is pregnant. such as amenorrhea, fatigue, nausea, vomiting, polyuria, breast changes(darkened areolae, melasma,enlarged Montgomery glands), quickening(slight fluttering movements of the fetus felt by the women, usually between 16-20 wks of gestation).

The nurse is caring for a​ 48-year-old obstetrical client. Which factor may be of most concern for the client based on the age of the​ client? A. Financial B. Childrearing C. Health D. Career

​B. Childrearing Rationale: The factor that may be of most concern to the client is the actual childrearing. The ability to deal with the needs of an older child as the client ages is of great concern. The older client is generally​ healthy, has established a​ career, and is financially secure.

The nurse is caring for a primigravida who is 38 years of age. Which factor should the nurse understand is associated with delaying​ childbearing? A. Increasing issues of infertility B. The incidence of later marriage C. Psychosocial issues D. The minimal options available for birth control for older women

​B. The incidence of later marriage Rationale: The incidence of later marriage is associated with the delay in childbearing. Infertility and psychosocial issues are factors in delaying pregnancy. There are​ more, not​ minimal, birth control options available

The pregnant client asks the nurse why she must do a glucose tolerance test. Which is an appropriate response by the​ nurse? A. ​"Hormones can alter carbohydrate metabolism and decrease maternal glucose​ levels." B. ​"Hormones can alter carbohydrate metabolism and increase maternal glucose​ levels." C. ​"Low fetus glucose levels can increase the​ mother's carbohydrate​ metabolism." D. ​"High fetus glucose levels can increase the​ mother's carbohydrate​ metabolism."

​B. ​"Hormones can alter carbohydrate metabolism and increase maternal glucose​ levels." Rationale: Hormonal influences may alter carbohydrate metabolism during​ pregnancy, leading to the development of gestational diabetes mellitus​ (GDM). Increased maternal glucose levels may cause the fetus to become large for gestational age​ (LGA), leading to potential complications for mother and fetus during and after delivery. Clients with an existing diagnosis of diabetes mellitus​ (DM) may develop vascular changes that impair fetal​ perfusion, resulting in a newborn that is small for gestational age​ (SGA). Glucose tolerance tests occur during pregnancy to screen for and diagnose GDM.

A pregnant client wants to know the cause for bloating and constipation. Which should be the​ nurse's reply? A. ​"Deceased progesterone causes delayed gastric​ emptying." B. ​"Increased progesterone causes delayed gastric​ emptying." C. ​"Decreased estrogen causes delayed gastric​ emptying." D. ​"Increased estrogen causes delayed gastric​ emptying."

​B. ​"Increased progesterone causes delayed gastric​ emptying." Rationale: Elevated progesterone levels result in smooth muscle​ relaxation, resulting in delayed gastric emptying and decreased peristalsis. As a​ result, the pregnant woman may complain of bloating and constipation. These symptoms are aggravated as the enlarging uterus displaces the stomach upward and the intestines are moved laterally and posteriorly. The cardiac sphincter also​ relaxes, and heartburn​ (pyrosis) may occur because of reflux of acidic secretions into the lower esophagus. Hemorrhoids frequently develop in late pregnancy from constipation and from pressure on vessels below the level of the uterus.

The nurse is providing information to a new colleague about the cardiovascular changes of the pregnant woman during pregnancy. Which statement by the new colleague indicates understanding? "Cardiac output increases." "The heart rate decreases." "Blood volume decreases." "The heart enlarges."

"Cardiac output increases." The maternal cardiovascular fluid volume increases during pregnancy, resulting in a cardiac output increase of 30-50%. The maternal heart rate and blood volume do not decrease during pregnancy. The maternal heart does not become enlarged during pregnancy.

A postpartum patient has chosen to breastfeed her newborn. The patient asks, "How do I know if a medication is safe to take while I am breastfeeding?" Which response by the nurse provides the best information for the patient? "Check the lactation category on the medication label. "Review the warnings on the medication label." "Call the registry listed under the contact portion of the medication label." "Most medications are not found in the breastmilk."

"Check the lactation category on the medication label." The lactation category contains information specifically related to the medication and breastfeeding. The warning subset does not specifically contain information on lactation. The purpose of the registry is to report a pregnancy exposure or enroll in the registry. Medication is found in breast milk.

he nurse is obtaining a history from a patient at 10 weeks of gestation who presented to the clinic with complaints of nausea and vomiting. Which subjective statement should prompt the nurse to contact the healthcare provider? "I am vomiting more than once a day." "I urinate only 4 times a day." "I have vomited twice in the past 2 days." "I have had nausea since I found out I was pregnant."

"I am vomiting more than once a day." A patient who is vomiting more than once a day is at risk for dehydration. Urinating 4 times a day, vomiting only twice in 2 days, or experiencing nausea throughout the first trimester of pregnancy are findings that do not place the patient at significant risk for dehydration or other complications.

Indications for Second trimester amniocentesis

-maternal age of 35 years or older -chromosomal abnormality in close family member -sex determination for maternal carrier of x-linked disorder -birth of previous infant with chromosomal abnormalities, neural tube defect, or body wall defect -pregnancy after multiple spontaneous abortions -elevated levels of maternal serum AFP that remain unexplained -Maternal Rh sensitixation (alloimmunization)- give RhoGam after procedure for RH- women

A patient in the first trimester of pregnancy asks, "What causes morning sickness?" Which response by the nurse provides the correct information? "Increased hCG levels can cause morning sickness." "Decreased levels of progesterone result in morning sickness." "Increased estrogen levels contribute to morning sickness." "Decreased testosterone levels can cause morning sickness."

"Increased hCG levels can cause morning sickness." Increased levels of hCG and changes in the carbohydrate metabolism are attributed to causing nausea and vomiting during the first trimester of pregnancy. Decreased progesterone levels, increased estrogen levels, and decreased testosterone are not contributing factors to morning sickness.

The nurse is discussing the effects of teratogens with a patient during preconceptual counseling. Which patient statement demonstrates understanding? "I will avoid drinking alcohol." "I will make sure I use sunscreen." "I will avoid all medications during the first trimester of pregnancy." "I understand that teratogenic effects can only occur during first trimester."

"I will avoid drinking alcohol." The statement made by the patient that demonstrates an understanding of teratogens is, "I will avoid drinking alcohol." Alcohol is a potential teratogen that can cause harm to the fetus. The sun does not have a teratogenic effect on the fetus. Many pregnant women need medication for therapeutic purposes, such as the treatment of infections, allergies, or other pathologic processes. Not all medications are teratogenic. Known teratogenic agents are not prescribed and usually can be replaced with medications that are considered safe. Although the first trimester is a critical time for teratogenesis, teratogenic effects can occur in any semester of the pregnancy.

A patient who is 10 weeks of gestation states, "I would love to hear my baby's heartbeat." Which statement by the nurse is accurate? "I will get the Doppler so you can hear the heartbeat." "The heartbeat cannot be heard yet." "The heartbeat can only be seen on ultrasound." "I can only hear the heartbeat with a fetoscope."

"I will get the Doppler so you can hear the heartbeat." The heartbeat can be detected by an ultrasonic Doppler, on average, at 8-12 weeks of gestation. The fetal heartbeat can be detected by fetoscope as early as week 16 and usually by 19 or 20 weeks of gestation.

Quadruple Screen Test

Quadruple Screen Test Combination of the Triple Screen hormones plus inhibin-A (hormone release by the placenta). The Triple or Quadruple Screen tests are more sensitive than the AFP alone (but higher rate of false positives). Gold standard test for genetic disorders is testing of fetal chromosomes/DNA.

A newly pregnant patient informs the nurse that she has a chronic health condition. Which instruction is most appropriate for the patient based on this information? "Inform your pharmacist about your pregnancy." "Continue with your current medications." "Stop all medications because they will harm the fetus." "Decrease the dosage of medication you are taking in half."

"Inform your pharmacist about your pregnancy." The instruction that the nurse will provide the patient is, "Inform your pharmacist about your pregnancy." It is important for a patient who is pregnant to utilize a specific pharmacy and inform the pharmacist of her pregnancy. The nurse will also notify the healthcare provider before advising the patient to continue or stop the use of current medications. Decreasing the dosage of a medication in half is not safe for the fetus or the patient, and it is not within the scope of practice for a nurse to change a prescribed ordered dose of medication. Additional Learning

The nurse is assessing a patient with a chronic illness who has expressed a desire to start a family. Which statement by the nurse is appropriate? "It is important to discuss your desire to start a family with the healthcare provider." "Before you try to get pregnant, it is important to stop taking your current medications." "After you get pregnant, you should stop taking your medications." "Prior to becoming pregnant, stop taking only the medication listed as harmful during pregnancy."

"It is important to discuss your desire to start a family with the healthcare provider." Preconceptual care is important to discuss with the healthcare provider in order to evaluate maternal health and routine medications on the effects of a fetus. Part of the healthcare provider's role is pharmacologic counseling and evaluation of current medications and their effects on the fetus.

A patient who is 6 weeks of gestation with a history of first trimester miscarriages is currently prescribed progesterone supplementation to help support the pregnancy. The patient asks, "What role does progesterone have in pregnancy?" Which response by the nurse is accurate? "It maintains the lining of the uterus and also stops the uterus from contracting." "It stimulates uterus development and contraction." "It stimulates estrogen production." "It helps the nourishment of the placenta and maintains placental development."

"It maintains the lining of the uterus and also stops the uterus from contracting." Progesterone, produced initially by the corpus luteum and then by the placenta, plays the greatest role in maintaining pregnancy. It maintains the endometrium and also inhibits spontaneous uterine contractility, thus preventing early spontaneous abortion due to uterine activity. Progesterone production is stimulated by human chorionic gonadotropin (hCG). The hormone hCG is secreted early in pregnancy by the trophoblast until the placenta is developed sufficiently to take over production. Additional estrogen supplementation is not required. Implantation occurs 7-10 days after conception.

The nurse preceptor and new nurse are reviewing the prenatal record of a patient. The new nurse asks, "What does the P represent in GTPAL?" Which response by the nurse preceptor is correct? "P represents the total number of preterm deliveries." "P is the total number of pregnancies regardless of outcome." "P represents the total number of term deliveries." "P indicates the total number of living children."

"P represents the total number of preterm deliveries." The letter P in the acronym GTPAL represents the total number of preterm deliveries after 20 weeks and before 37 weeks of gestation. G, or gravida, refers to the total number of pregnancies, regardless of the outcome. T, or term, refers to the total number of term deliveries after 37 weeks of gestation. L, or living, refers to the total number of living children.

The nurse is discussing the benefits of attending childbirth classes with a couple expecting their first child. Which statement should be excluded from the discussion? "The classes will provide instruction on how to have a pain-free labor and delivery." "The classes will allow you to share your feelings about pregnancy and birth." "The classes will provide information about pregnancy, labor and delivery, and the postpartum period." "The classes are beneficial in improving coping mechanisms during the labor and delivery period."

"The classes will provide instruction on how to have a pain-free labor and delivery." A pain-free labor and delivery are not realistic options. Labor and delivery are associated with some pain. The goal is to provide guidance as to what will occur, when, why, and what parents can do to cope or find comfort through the difficult aspects of labor and delivery. Prenatal education programs provide important opportunities to share information about pregnancy and childbirth and to enhance the parents' decision-making skills.

patient experiencing her first pregnancy asks the nurse, "After conception, when is the sex of the baby determined?" Which response by the nurse provides accurate information? "The sex of your baby is determined at the moment of fertilization." "The sex of the baby is established after multiple cellular divisions." "The sex of the baby is determined when the fertilized egg is implanted in the uterine wall." "The sex of your baby is determined during the first phase of cellular division."

"The sex of your baby is determined at the moment of fertilization." the true moment of fertilization occurs as the nuclei unite. Their individual nuclear membranes disappear, and their chromosomes pair up to produce the diploid zygote. Because each nucleus contains a haploid number of chromosomes (23), this union restores the diploid number (46). The zygote contains a new combination of genetic material that results in an individual different from either parent and from anyone else. The sex of the zygote is determined at the moment of fertilization. The two chromosomes (the sex chromosomes) of the 23rd pair—either XX or XY—determine the sex of an individual.

the nurse is informing a pregnant patient that a routine indirect Coombs test has been ordered. The patient asks why this is being performed. Which response from the nurse is accurate? "The test will screen your baby for genetic issues and let us know what further testing should be done." "The test will determine if the baby has Down syndrome." "The test will let you know the baby's blood type." "The test will determine if you have antibodies that the baby may not have."

"The test will determine if you have antibodies that the baby may not have." The indirect Coombs test indicates whether red blood cell (RBC) antibodies are present (either Rhesus or non-Rhesus). A number of RBC antigens may cause isoimmunization, and fetal and newborn hemolytic disease. The most common of these is the D antigen, which may occur when an Rh-negative mother carries an Rh-positive fetus. This may be prevented through prenatal administration of Rh immune globulin (Rhogam).

When is the first fetal movement?

18 weeks for first time mom and possibly earlier for second time mom

Nageles rule for calculating a due date is?

1st day of the last menstrual period Add 7 days Subtract 3 months

Alpha-fetoprotein screening

-AFP assessment is performed on maternal serum or amniotic fluid to identify: -Open body wall defects -Chromosomal anomalies -Three other markers are often assessed with AFP -Human chorionic gonadotropin -Estriol -Inhibin A

Amniotic fluid functions

-Cushions against impact -Maintains temp -Promotes normal fetal development- allows symmetric dev., keeps membranes from sticking, provides room for buoyancy and movement -fluid comes from fetal urine and from membranes -swallowed and absorbed by fetal digestive tract _absorbed by fetal lungs to promote breathing -Merconium -500-1000ml at term

The nurse is preparing to assess a patient who states, "I have felt the baby move for the past few weeks." Which fundal height measurement should the nurse anticipate based on the patient's statement? 21 cm 14 cm 10 cm 34 cm

21 cm Based on the patient's statement, the nurse can anticipate a fundal height of 21 cm. The measurement of the fundal height is not accurate prior to 20 weeks of gestation. Fetal movement can occur anywhere between 16 and 22 weeks of gestation. Fundal height in centimeters correlates well with weeks of gestation after 20 weeks. The normal variation is gestational weeks plus or minus 2 cm. A fundal height of 34 cm is an abnormal finding associated with the patient feeling fetal movement over the past few weeks.

Based on the nurse's understanding of conception, in which time frame does implantation occur post-fertilization 7-10 days 3-5 days 24 hours 2 weeks

7-10 days Implantation occurs between 7 and 10 days after fertilization. The blastocyst implants in the uterine wall 7-10 days after fertilization.

Placenta

A structure that allows an embryo to be nourished with the mother's blood supply HCG causes progesterone to continue from the corpus luteum for 6-8 weeks until placenta takes over. HCG cause male fetus to secrete testosterone for testicular development. Estrogen-enlargement of breasts, uterus, and external genetalia. maintains pregnancy Progesterone- grows and nurtures the decidua. Maintains pregnancy

umbilical cord

AVA Veins carry oxygenated blood and nutrients cushioned by Wharton's jelly-prevents obstruction by fetus

The nurse is assessing the pregnant patient using the Leopold maneuvers. Which assessment finding would the nurse determine with Leopold maneuvers? Breech position Gender of the neonate Multiple gestation Amniotic fluid index

Breech position The Leopold maneuvers are used to assess fetal position and orientation. The Leopold maneuvers are not used to assess the gender, multiple gestation, or amniotic fluid index.

When does the fundal height correlate with weeks of gestation?

After 20 weeks

fetal membranes

amnion- inner membrane chorion-outer membrane together called BOW-bag of waters

hPL (human placental lactogen)

antagonist of insulin, makes sure that the baby gets enough glucose, minerals and protein.

The nurse preceptor is teaching a new graduate nurse in the fertility clinic. The preceptor asks, "When is the sex of the zygote determined?" Which response by the new graduate nurse is accurate? At the moment of conception 14 days after conception After mitosis During the morula phase

At the moment of conception The sex of the zygote is determined at the moment of fertilization. The two chromosomes (the sex chromosomes) of the 23rd pair—either XX or XY—determine the sex of an individual.

The nurse is caring for a pregnant client who expresses concern about the older siblings adjusting to the baby. Which response by the nurse will help promote the older​ siblings' acceptance of the​ baby? A. ​"It is important you spend time with your older children before the baby is​ born." B. ​"You are welcome to bring your children to your prenatal​ appointment." C. ​"They will most likely get used to the new baby after the​ birth." D. ​"Make sure you give them extra attention after the baby is​ born."

B. ​"You are welcome to bring your children to your prenatal​ appointment." ​Rationale: The response that will promote the acceptance of a new baby​ is, "You are welcome to bring your children to your prenatal​ appointment." Pregnant women may find it helpful to bring their children to a prenatal visit after they have been told about the expected baby. The children are encouraged to become involved in prenatal care and to ask any questions they may have. They are also given the opportunity to hear the fetal​ heartbeat, either with a stethoscope or with the Doppler device. This helps make the baby more real to them. The remaining statements do not promote the acceptance of a new baby.

What is the NST- Nonstress test

assesses fetal well being -evaluates fetal heart rate accelerations, with or w/o fetal movement -reactivity is associated with adequate fetal oxygenation and intact neural pathways -FHR reactivity may not develop until 32 weeks in fetus

Positive signs of pregnancy

audible fetal heartbeat, fetal movement felt by examiner, ultrasound visualization of fetus, palpation of the fetal outline

Relaxin

inhibits uterine activity, softens cervix, remodels collagen

The nurse is teaching a group of new nurses about fetal circulation. The nurse should identify that which fetal shunt allows most of the fetal blood to bypass the liver? Ductus venosus Foramen ovale Ductus arteriosus Umbilical vein

Ductus venosus There are three shunts that allow fetal blood to flow into the heart and brain, bypassing other organs in the body. The ductus venosus allows blood to flow from the umbilical vein into the heart, bypassing the liver. The foramen ovale connects the right and left atria. The ductus arteriosus allows blood flow from the aorta to the lower body. The umbilical vein is not a fetal shunt.

What are the 5 parameters of the Biophysical profile?

Each scored 2 for normal, 0 abnormal 1.reactive FHR w/ activity 2.Fetal Breath movements 3. Gross Fetal movements-extension 4.Fetal Tone 5. Amniotic fluid Volume > 5cm

The nurse is providing a patient information about the physiological changes that can be expected during each trimester. Which trimester(s) should the nurse tell the patient to expect to experience some urinary frequency? First and third All trimesters Second First

First and third When discussing urinary frequency, the nurse will include the first and third trimesters of pregnancy. In the first trimester, the enlarging uterus presses against the bladder, producing urinary frequency. In the third trimester, the presenting part descends into the pelvis and again presses on the bladder, reducing bladder capacity, contributing to hyperemia, and irritating the bladder. Urinary frequency occurring in the second trimester may indicate a urinary tract infection.

Estrogen

Female sex hormone growth hormone, helps develop ductal system of breasts

Para (TPAL)

Gravida- any pregnancy term preterm abortion living children G+T+P+A+L

The nurse assessing the fundal height of a patient notes that the measurement is greater than 6 cm in relation to the gestational week of pregnancy. Which condition should the nurse consider as to the possible cause of the increase in fundal height based on the findings? Hydramnios Breech presentation Oligohydramnios Large for gestational age

Hydramnios The assessment findings may be associated with hydramnios. Hydramnios is a condition in which excess amniotic fluid accumulates during pregnancy resulting in a significant increase in the fundal height. Other indications include multiple pregnancy. A breech presentation, oligohydramnios, or a neonate large for gestational age do not significantly increase the fundal height of a patient

preterm/ premature labor postterm labor

labor occurs between 20-37 weeks labor occurs after 42 weeks

fertilization occurs

occurs when sperm enter ova and 2 nuclei of parent gametes merge. Fallopian tube

Spermatogenesis

production of sperm begins at puberty produced throughout males lifetime

Placental Circulation

provides for oxygenation of fetus while bypassing lungs.

A pregnant patient reports headaches but the nurse can find no medical issues causing the pain. The nurse should suggest which complementary therapy to help relieve the pain? Massage Herbal remedies Vitamin B6 Cognitive-behavioral therapy

Massage Massage therapy helps reduce back pain in pregnant patients. Herbal remedies may have teratogenic effects, so the nurse would not suggest this type of alternative therapy. Vitamin B6 helps with nausea. Cognitive-behavioral therapy may help with anxiety and depression.

conception

Mature ovum may be fertilized for 24 hours sperm may live 24-80 hours in female reproductive tract ovulation occurs 14 days prior to next cycle corpus luteum secretes estrogen and progesterone which prepare the endometrium for pregnancy ova and zygote have no motile power. high estrogen levels increase peristalsis w/i fallopian tibes and movement of cilia transport ova sperm remove outside covering/ secrete enzyme to penetrate ovum membranes

The nurse prepares to measure the fundal height of a pregnant patient. Which technique should the nurse use to obtain an accurate fundal height in centimeters? Measure the abdomen from the top of the symphysis pubis to the top of the fundus of the uterus. Measure the abdomen from the symphysis pubis to the bottom of the patient's breasts. Measure the abdomen from the symphysis pubis to the sternum, above the fundus. Measure from the top of the symphysis pubis to the umbilicus.

Measure the abdomen from the top of the symphysis pubis to the top of the fundus of the uterus. The proper technique used to measure the fundal height of a patient after 20 weeks of gestation is to measure from the top of the symphysis pubis to the top of the fundus of the uterus in centimeters.

What are the maternal indications for ultrasounds?

shortened cervical length cervical incompetence vaginal bleeding

Oogenesis

the production, growth, and maturation of an egg, or ovum begins in prenatal life-all ova developed by 30th week of gestation.

A patient asks if a routine medication is safe during pregnancy. Which category of the medication label should the nurse instruct the patient to review? Yellow label on the medication bottle Pregnancy Warning label Lactation

Pregnancy The category of the medication label the nurse will instruct to patient to refer to is pregnancy. The FDA has added categories to medication labeling that includes information related to pregnancy, lactation, and male and female reproductive potential.

chorionic villus sampling (CVS)

Prenatal diagnostic technique that involves taking a sample of tissue from the chorion. done 10-12 weeks DNA sampling -Does not detect neural tube defects

patient states, "I took a pregnancy test at home and it was positive." Based on the patient's statement, which indicator of pregnancy should the nurse understand the test result to be reflective of? Probable indicator of pregnancy Presumptive indicator of pregnancy Positive indicator of pregnancy Possible indicator of pregnancy

Probable indicator of pregnancy The nurse understands that a positive home pregnancy test is a probable (objective) indicator of pregnancy. While these are objective changes that occur in pregnancy, these changes can have other causes as well. Therefore, they do not confirm pregnancy. Presumptive indicators are subjective reports from the patient. For example, pregnancy tests are based on analysis of maternal blood or urine for the detection of hCG, the hormone secreted by the trophoblast. These tests are not considered positive signs of pregnancy because the similarity of hCG and the pituitary-secreted LH occasionally results in cross-reactions. In addition, certain conditions other than pregnancy can cause elevated levels of hCG. Positive signs of pregnancy are direct indicators (diagnostic changes) that include fetal heart tones and movement. Presumptive changes are subjective changes of pregnancy that the woman reports. The term "possible" is not an indicator of pregnancy.

antepartum intrapartum postpartum

time between conception and onset of labor (prenatal) time from onset of true labor until after birth of infant and placenta time from birth until women's body returns to prepregnant conditions

Interpretation of Nonstress test

Reactive Test- desired, baseline FHR 130-160, accelerations of FHR of> 15 beats/min, at least 2 accelerations with fetal movement, lasting at least 15 seconds, over at least 20 mins of monitoring -Nonreactive test-criteria not met -unsatisfactory-data can't be interpreted or inadequate fetal activity

A pregnant patient in the second trimester of pregnancy is currently taking an antibiotic, tetracycline, for acne. Which effect should the nurse anticipate the tetracycline may have on the fetus? Staining of the teeth No effect Birthmarks Exaggerated skeletal growth

Staining of the teeth Tetracycline is a teratogenic drug that is known to cause staining of the teeth in children when taken in late pregnancy. A teratogenic drug does not cause birthmarks. The use of tetracycline can result in depressed skeletal growth.

Question REVIEWING 19 of 32 Which role does the human placental lactogen (hPL) play in placental function? Stimulates maternal tissue insulin resistance during the second half of pregnancy. Enlarges the uterus, external genitalia, and the ductal system of the breasts. Maintains the endometrium and reduces uterine muscle contractions to prevent spontaneous abortion. Preserves the corpus luteum, making the endometrium more hospitable to the pregnancy.

Stimulates maternal tissue insulin resistance during the second half of pregnancy. Human placental lactogen (hPL), or human chorionic somatomammotropin (hCS), stimulates maternal tissue insulin resistance during the second half of pregnancy. This is necessary to provide more glucose to the fetus. Estrogen enlarges the uterus, external genitalia, and the ductal system of the breasts. Progesterone is essential in maintaining the endometrium and reducing uterine muscle contractions to prevent spontaneous abortion. Human chorionic gonadotropin (hCG) is a glycoprotein that preserves the corpus luteum, making the endometrium more hospitable to the pregnancy.

The nurse teaching a prenatal class is asked by a participant why backaches occur during pregnancy. Prior to answering the question, which best describes the nurse's understanding of back discomfort during pregnancy? The expanding uterus exaggerates the lumbosacral curve. The expanding uterus pushes down on the symphysis pubis. The expanding uterus pushes upward on the thoracic cage. The expanding uterus places pressure on the sacrum.

The expanding uterus exaggerates the lumbosacral curve. Back discomfort in pregnancy occurs as a result of the expanding uterus exaggerating the lumbosacral curve. The symphysis pubis has no relation to the spine. The upward pressure on the thoracic cage is not associated with back pain. Sacral pressure is unrelated to the general discomfort of the lumbar sacral area experienced as the pregnancy advances.

The nurse reviews fetal development with a patient who is 24 weeks of gestation. Which physiological milestone should the nurse expect at this stage of the pregnancy? The fetus is viable. Vernix caseosa begins to disappear The fetal lungs begin producing surfactant. The fetal heart tones are audible.

The fetus is viable. Based on the nurse's understanding of the physiological development of the fetus, the milestone the fetus has reached is that it is viable. Vernix caseosa begins to disappear between 38 and 40 weeks of gestation. Surfactant production begins between 30 and 34 weeks of gestation. The fetal heart tones are audible between 17 and 20 weeks of gestation.

embryonic period

The stage of prenatal development from approximately the third through the eighth week after conception, during which the basic forms of all body structures, including internal organs, develop. -during this period , organs are especially vulnerable to teratogens

A patient who is in the second trimester of pregnancy states, "I have to go to the bathroom all the time." Which test should the nurse anticipate the healthcare provider to order based on the patient's statement? Urinalysis Bladder scan Hematocrit and hemoglobin Sexually transmitted infection (STI) panel

Urinalysis The nurse should anticipate that the healthcare provider will prescribe a urinary analysis. Urinary frequency is not a normal finding during the second trimester of pregnancy and may be indicative of a urinary tract infection. A bladder scan, hematocrit and hemoglobin, or an STI panel are not used to diagnose a urinary tract infection.

A patient at 8 weeks of gestation is experiencing nausea and vomiting. The patient's vital signs are stable. Which treatment should the nurse anticipate to be used first for the patient? Vitamin B6 and the antihistamine doxylamine An over-the-counter antiemetic drug and ginger The prescription antiemetic, Zofran The prokinetic drug Reglan

Vitamin B6 and the antihistamine doxylamine Vitamin B6, and an antihistamine are used to treat nausea and vomiting in early pregnancy and are considered the first-line treatment. Ginger may also be used. Antihistamine H1-receptor blockers, phenothiazines, and antinausea medications such as promethazine (Phenergan), metoclopramide (Reglan), and ondansetron (Zofran) are considered safe and effective for treating refractory cases. In severe cases, methylprednisolone, a steroid, may be used, but as a last resort because it poses a potential risk to the fetus.

pregnant patient informs the nurse that she is taking an herbal remedy for headaches. Which question by the nurse is the most important to ask? "What herbal remedy are you using?" "Does your remedy relieve your headache?" "When did you start using the herb?" "When was the last time you had a headache?"

What herbal remedy are you using?" It is important for the nurse to assess what the fetus has been exposed to and formulate a plan of care that includes further assessment of the use of alternative therapies, as well as provide teaching on the potential teratogenic effects alternative therapies may have. Inquiring about relief of the headache, when the herb was first used, and the last time the patient had a headache does not provide the immediate assessment information that is required.

NIPT (non-invasive prenatal testing)

detects fetal alleles in maternal serum from 9 weeks on

transvaginal ultrasound benefits

estimation of birth weight-should coordinate with week detection of fetal abnormalities exam of nuchal translucency (NTT)-down syndrome exam of fetal cardiac structures exam placenta-intact/ location amniotic fluid index (normal 5-24 cm) can detect fetal death *** detect shortened cervical length or funneling*** determination of fetal position, presentation

What are the diagnostic benefits of Amniocentesis?

evaluate fetal health detect genetic disorders- down syndrome, trisomy 18, neural tube defects evaluate lung maturity- components of surfactant-lecithin/ sphingomyelin ratio (L/S)

Probable signs of pregnancy

examiner suspects a women is pregnant. such as abdominal enlargement, hegar's sign(softening and compressibility of the lower uterus), chadwick's sign (deepened violet-bluish color of the cervix and vaginal mucosa), goodell's sign(softening of the cervical tip), ballottement, braxton hicks, positive pregnancy test, fetal outline felt by examiner. Abdominal enlargement, ballottment, uterine souffle

pre-embryonic period

fertilization to week 2 - fertilized ovum advances through the fallopian tube toward the uterus and undergoes miotic division, becoming a ZYGOTE - zygote reaches the uterus about day 3-4 days after fertilization -implantation 2-4 days after zygote enters uterus -pregnant endometrium now called DECIDUA -Zygote secretes HCG to signal pregnancy has begun. POS PREGO TEST -HCG tells corpus luteum to continue to secrete estrogen and progesterone -Implantation usually begins in the fundus( upper Part) of the uterus 6-10 days after conception

gestation abortion term

gestation- number of weeks since first day of last menstrual period abortion-birth that occurs before end of 20 weeks gestation term-normal duration of pregnancy

Prostaglandins

help initiate labor

Progesterone

hormone produced by the corpus luteum in the ovary and the placenta of pregnant women maintains endometrium + inhibits uterine contractility helps develop ductal system of breats

A pregnant client who has been diagnosed with a​ yeast, Candida​, infection says she never had one before. Which is an appropriate response by the​ nurse? A. ​"The decreased blood flow to the vagina increases the risk of yeast​ infections." B. ​"There is a decrease in the acidity of the vaginal​ fluid, which favors​ yeast." C. ​"There is an increase in the acidity of the vaginal​ fluid, which favors​ yeast." D. ​"The increased blood flow to the vagina increases the risk of yeast​ infections."

​ B. ​"There is a decrease in the acidity of the vaginal​ fluid, which favors​ yeast." Rationale: During​ pregnancy, estrogen causes a thickening of the vaginal​ mucosa, a loosening of the connective​ tissue, and an increase in vaginal secretions. These secretions are​ thick, white, and acidic​ (pH 3.5dash ​6.0). The acid pH favors the growth of yeast​ organisms, thereby making the pregnant woman more susceptible to Candida infection than usual. Blood flow to the vagina is increased during pregnancy but this does not increase the risk of developing a yeast infection.

The nurse is preparing to discharge an adolescent client who is 2​ days' postpartum. Which question by the nurse addresses the developmental task of the​ client? A. ​"Is the father of the baby​ involved?" B. ​"Do you plan on returning to​ school?" C. ​"Have you thought about what birth control you will be​ using?" D. ​"Have you made the​ follow-up appointment for the​ baby?"

​ B. ​"Do you plan on returning to​ school?" Rationale: The most appropriate question the nurse can ask the adolescent client​ is,"Do you plan on returning to​ school?" Due to the fact that teen mothers are less likely to finish high​ school, the nurse has the opportunity to evaluate the​ client's plans and collaborate with a social worker to assist the client in returning to school. The remaining responses do not address the development tasks of the client.

The nurse is using a Doppler device to detect the fetal heart rate. Which fetal heart rate is within the normal​ range? A. 160-200 ​beats/min B. 180-240 ​beats/min C. 110-160 ​beats/min D. 100-140 ​beats/min

​ C. 110-160 ​beats/min Rationale: The fetal heart rate is between 110 and 160​ beats/min and must be counted and compared with the maternal pulse for differentiation. Auscultation of the abdomen may reveal sounds other than that of the fetal heart. The maternal​ pulse, emanating from the abdominal​ aorta, may be unusually​ loud, or a uterine souffle may be heard.

he nurse is working in a free clinic. A pregnant client presents with her first child and states she is feeling the baby move. The client asks how far along she is. Which is the correct response by the​ nurse? A. 18-20 weeks B. 16-18 weeks C. 14-16 weeks D. 20-22 weeks

​A. 18-20 weeks Rationale: Quickening, or the​ mother's perception of fetal​ movement, occurs about 18-20 weeks after the last menstrual period​ (LMP) in a woman pregnant for the first​ time, but may occur as early as 16 weeks in a woman who has been pregnant before. Quickening is a fluttering sensation in the abdomen that gradually increases in intensity and frequency.

The nurse is caring for an obstetrical client who expresses feeling stressed over the impending delivery of the baby. Which nursing intervention is most appropriate for the​ client's situation? A. Encourage the expression of concerns. B. Reassure the client that everything will be fine. C. Provide relaxation techniques. D. Notify social services.

​A. Encourage the expression of concerns. Rationale: The nursing intervention most appropriate for the client who communicates feeling stressed over the impending delivery of her baby is to encourage the client to express her concerns. Notifying social services is unwarranted. Providing relaxation techniques and reassuring the client that everything will be fine does not address the​ client's concerns.

The client asks the nurse how​ over-the-counter pregnancy tests work. Which hormone should the nurse identify a being recognized by the test to confirm a positive​ result? A. Human chorionic gonadotropin​ (hCG) B. ​Gonadotropin-releasing hormone​ (GnRH) C. Luteinizing hormone​ (LH) D. ​Follicle-stimulating hormone​ (FSH)

​A. Human chorionic gonadotropin​ (hCG) Rationale: The​ over-the-counter pregnancy tests detect a subunit of hCG to confirm a pregnancy.​ LH, FSH, and GnRH are not hormones measured to confirm a pregnancy. The hormone hCG is produced by the placenta and prevents involution of the corpus luteum at the end of the menstrual cycle. It also stimulates the corpus luteum to secrete increased amounts of estrogen and progesterone. The hCG levels normally peak in the pregnant client at 10dash 12 weeks gestation. There is a rapid decline in the hCG level until 22 weeks gestation.

When caring for an older woman who is​ pregnant, which factor should the nurse most anticipate as affecting the care and outcome of the​ pregnancy? A. Medical procedures B. Chronic illness C. Surgical procedures D. Postpartum recovery

​A. Medical procedures Rationale: The factor that will affect the care and outcome of the pregnancy of an older woman is the increased medical procedures that are offered. Medical procedures such as​ amniocentesis, ultrasound, and antepartum testing are more likely to be performed for an older woman. Chronic​ illness, postpartum​ recovery, and surgical procedures are not primary factors that are likely to affect the care and outcome of a pregnancy.

The nurse is caring for a client in the first trimester of pregnancy who is concerned about having sexual intercourse. Which response by the nurse is the most​ appropriate? A. ​"As long as there are no​ complications, intercourse is​ safe." B. ​"It is best that you abstain from intercourse until you are in your second​ trimester." C. ​"It is best if you discuss this with your healthcare​ provider." D. ​"Intercourse is safe during the first two trimesters of​ pregnancy."

​A. ​"As long as there are no​ complications, intercourse is​ safe." Rationale: The client can be advised that intercourse is safe anytime during pregnancy as long as there are no complications. Intercourse is not restricted to any specific trimester of pregnancy.

A client asks the nurse​ "When is the most fertile time of a​ woman?" Which is the most appropriate​ answer? A. Day 14 of the menstrual cycle B. 12-24 hours after ovulation C. 24-48 hours after ovulation D. Day 16 of the menstrual cycle

​B. 12-24 hours after ovulation Rationale: Ova are considered fertile for about 12-24 hours after ovulation. Menstruation usually occurs around day 14 of the menstrual cycle with a normal​ 28-day cycle.

he nurse is assessing a pregnant client at 30​ weeks' gestation. Which cardiovascular change should the nurse consider when taking the​ client's vital​ signs? A. Red blood cell count is decreased. B. Plasma volume is decreased. C. Cardiac output is increased. D. Heart rate is decreased.

​C. Cardiac output is increased. Rationale: The cardiovascular change that occurs during pregnancy is an increased cardiac output. Cardiac output begins to increase early in pregnancy and peaks at 25- 30 ​weeks' gestation at 30dash ​50% above​ pre-pregnancy levels. It generally remains elevated in the third trimester. The heart rate increases to accommodate the additional cardiovascular volume. The plasma volume increases by​ 50%, while the red blood cell count only increases​ 25%, resulting in physiologic anemia of pregnancy.

A pregnant client asks the​ nurse, "What is this dark line on my​ abdomen?" Which response should the nurse provide the​ client? A. ​"That is called a linea ova and only occurs during​ pregnancy." B. ​"That line is referred to as linea alba and occurs commonly during​ pregnancy." C. ​"That is known as linea nigra and is a common finding during​ pregnancy." D. ​"That is called a linear demarcation and is common during​ pregnancy."

​C. ​"That is known as linea nigra and is a common finding during​ pregnancy." Rationale: The linea alba refers to the midline of the abdomen from the pubic area to the umbilicus and xiphoid process of the sternum. During​ pregnancy, this area darkens and is referred to as the linea nigra.

Which factor may more significantly impact an older woman experiencing a spontaneous abortion compared to a younger​ woman? A. Loss of maternal identity B. Grief over the loss C. Financial loss D. Anxiety over the ability to conceive again

​D. Anxiety over the ability to conceive again Rationale: The factor that significantly impacts an older woman who has experienced a spontaneous abortion is the anxiety over the ability to conceive again. The anxiety is due to the​ "biological clock," or the remaining time left to conceive again. Financial loss is not directly associated with a spontaneous abortion. Women of all ages that have experienced a loss of pregnancy experience grief. The loss of maternal identity is experienced by women of different ages and is based on specific circumstances such as infertility and the inability to conceive.

The nurse is assessing a​ first-time pregnant client who is 19 weeks after her last menstrual period​ (LMP). Which finding should the nurse expect to be first noted at this​ time? A. Urinary frequency B. Nausea and vomiting C. Breast tenderness D. Fluttering sensation in the abdomen

​D. Fluttering sensation in the abdomen Rationale: Quickening, or the​ mother's perception of fetal​ movement, occurs about 18-20 weeks after the last menstrual period​ (LMP) in a woman pregnant for the first​ time, but may occur as early as 16 weeks in a woman who has been pregnant before. Quickening is a fluttering sensation in the abdomen that gradually increases in intensity and frequency. Nausea and​ vomiting, commonly called morning​ sickness, can occur anytime during the day and occur frequently during the first trimester. Changes in breast​ tissue, often noted by tenderness and​ tingling, occur early in the pregnancy. Urinary frequency is experienced in the first trimester as the enlarging uterus presses on the bladder.

The nurse working in a prenatal clinic provides care for clients of diverse cultures. Which action will foster the delivery of more​ effective, culturally competent care by the​ nurse? A. Identifying personal religious and cultural beliefs B. Sharing the​ nurse's cultural beliefs with the clients C. Including the use of family members as language interpreters D. Identifying personal biases and prejudices

​D. Identifying personal biases and prejudices Rationale: Identifying personal biases and prejudices will foster the delivery of more​ effective, culturally competent care by the nurse. Religious and cultural beliefs should be critically​ examined, not merely identified. Sharing personal cultural beliefs is not appropriate when caring for a client. The services of a professional interpreter are used when a language barrier exists.

The nurse is caring for a client who has been diagnosed with physiologic anemia of pregnancy. Which accurately describes the​ nurse's understanding of physiologic anemia in relation to​ pregnancy? A. The client has decreased plasma. B. The client has increased red blood cells. C. The client has decreased concentration of red blood cells. D. The client has increased plasma.

​D. The client has increased plasma. Rationale: A plasma increase of​ 50% results in physiologic anemia of pregnancy. During​ pregnancy, the red blood cell​ (RBC) count increases by​ 25%, but this is considered decreased secondary to the hemodilution. Because the plasma volume increase​ (50%) is greater than the RBC increase​ (25%), the​ hematocrit, which measures the concentration of RBCs in the​ plasma, decreases slightly. This decrease is referred to as the physiologic anemia of pregnancy​ (pseudoanemia).